Surgical approaches to adenocarcinoma of the gastroesophageal junction: the Siewert II conundrum.

BACKGROUND: The Siewert classification system for gastroesophageal junction adenocarcinoma has provided morphological and topographical information to help guide surgical decision-making. Evidence has shown that Siewert I and III tumors are distinct entities with differing epidemiologic and histologic characteristics and distinct patterns of disease progression, requiring different treatment. Siewert II tumors share some of the characteristics of type I and III lesions, and the surgical approach is not universally agreed upon. Appropriate surgical options include transthoracic esophagogastrectomy, transhiatal esophagectomy, and transabdominal extended total gastrectomy. PURPOSE: A review of the available evidence of the surgical management of Siewert II tumors is presented. CONCLUSIONS: Careful review of the data appear to support the fact that a satisfactory oncologic resection can be achieved via a transabdominal extended total gastrectomy with a slight advantage in terms of perioperative complications, and overall postoperative quality of life. Overall and disease-free survival compares favorably to the transthoracic approach. These results can be achieved with careful selection of patients balancing more than just the Siewert type in the decision-making but considering also preoperative T and N stages, histological type (diffuse type requiring longer margins that are not always achievable via gastrectomy), and the presence of Barrett\u27s esophagus

Sterile neutrinos as subdominant warm dark matter

In light of recent findings which seem to disfavor a scenario with (warm) dark matter entirely constituted of sterile neutrinos produced via the Dodelson-Widrow (DW) mechanism, we investigate the constraints attainable for this mechanism by relaxing the usual hypothesis that the relic neutrino abundance must necessarily account for all of the dark matter. We first study how to reinterpret the limits attainable from X-ray non-detection and Lyman-alpha forest measurements in the case that sterile neutrinos constitute only a fraction fs of the total amount of dark matter. Then, assuming that sterile neutrinos are generated in the early universe solely through the DW mechanism, we show how the X-ray and Lyman-alpha results jointly constrain the mass-mixing parameters governing their production. Furthermore, we show how the same data allow us to set a robust upper limit fs < 0.7 at the 2 sigma level, rejecting the case of dominant dark matter (fs = 1) at the ~ 3 sigma level.Comment: Minor changes; added references; version accepted for publication in Phys. Rev.

A standardized comparison of peri-operative complications after minimally invasive esophagectomy: Ivor Lewis versus McKeown.

BACKGROUND: While our institutional approach to esophageal resection for cancer has traditionally favored a minimally invasive (MI) 3-hole, McKeown esophagectomy (MIE 3-hole) during the last five years several factors has determined a shift in our practice with an increasing number of minimally invasive Ivor Lewis (MIE IL) resections being performed. We compared peri-operative outcomes of the two procedures, hypothesizing that MIE IL would be less morbid in the peri-operative setting compared to MIE 3-hole. METHODS: Our institution\u27s IRB-approved esophageal database was queried to identify all patients who underwent totally MI esophagectomy (MIE IL vs. MIE 3-hole) from June 2011 to May 2016. Patient demographics, preoperative and peri-operative data, as well as post-operative complications were compared between the two groups. Post-operative complications were analyzed using the Clavien-Dindo classification system. RESULTS: There were 110 patients who underwent totally MI esophagectomy (MIE IL n = 49 [45%], MIE 3-hole n = 61 [55%]). The majority of patients were men (n = 91, 83%) with a median age of 62.5 (range 31-83). Preoperative risk stratifiers such as ECOG score, ASA, and Charlson Comorbidity Index were not significantly different between groups. Anastomotic leak rate was 2.0% in the MIE IL group compared to 6.6% in the MIE 3-hole group (p = 0.379). The rate of serious (Clavien-Dindo 3, 4, or 5) post-operative complications was significantly less in the MIE IL group (34.7 vs. 59.0%, p = 0.013). Serious pulmonary complications were not significantly different (16.3 vs. 26.2%, p = 0.251) between the two groups. CONCLUSIONS: In this cohort, totally MIE IL showed significantly less severe peri-operative morbidity than MIE 3-hole, but similar rates of serious pulmonary complications and anastomotic leaks. These findings confirm the safety of minimally invasive Ivor Lewis esophagectomies for esophageal cancer when oncologically and clinically appropriate. Minimally invasive McKeown esophagectomy remains a satisfactory and appropriate option when clinically indicated

Developing corporate communications: insights from the Italian scenario

Purpose - Based on business manager perceptions in large firms, this paper explores the emergence, growth and importance of corporate communications and how it is evolving and creating competitive advantage in Italian firms. Design/methodology/approach - A qualitative approach is deployed, comprising depth interviews with senior managers from corporations from a broad spectrum of industries including: energy, telecommunications, automotive, transport, retail chain, appliances, technology and engineering, private shipping, government-owned holdings, marketing consultancy, and construction. Findings - The paper provides insights of corporate communication (corpcom) practices in the sampled companies. The research shows that corpcoms involves a complex range of activities leading to performances managed and implemented under CEO direction. Practical implications - Corpcoms is perceived as a strategic concept with effective application relative to managing corporate image and reputation. The findings offer insights for communication professionals who deal with corpcoms, branding, and marketing communications. Originality/value - Corpcoms can be viewed via lens of social actors’ perspectives, i.e. via practitioners – including brand managers and senior executives as they possess practical knowledge of contextual business setting and the managerial capacity to design and implement integrated corporate communications

Early Detection Of Metabolic And Energy Disorders By Thermal Time Series Stochastic Complexity Analysis.

Maintenance of thermal homeostasis in rats fed a high-fat diet (HFD) is associated with changes in their thermal balance. The thermodynamic relationship between heat dissipation and energy storage is altered by the ingestion of high-energy diet content. Observation of thermal registers of core temperature behavior, in humans and rodents, permits identification of some characteristics of time series, such as autoreference and stationarity that fit adequately to a stochastic analysis. To identify this change, we used, for the first time, a stochastic autoregressive model, the concepts of which match those associated with physiological systems involved and applied in male HFD rats compared with their appropriate standard food intake age-matched male controls (n=7 per group). By analyzing a recorded temperature time series, we were able to identify when thermal homeostasis would be affected by a new diet. The autoregressive time series model (AR model) was used to predict the occurrence of thermal homeostasis, and this model proved to be very effective in distinguishing such a physiological disorder. Thus, we infer from the results of our study that maximum entropy distribution as a means for stochastic characterization of temperature time series registers may be established as an important and early tool to aid in the diagnosis and prevention of metabolic diseases due to their ability to detect small variations in thermal profile.4770-

Arithmetic fuchsian groups and space time block codes

In the context of space time block codes (STBCs) the theory of arithmetic Fuchsian groups is presented. Additionally, in this work we present a new class of STBCs based on arithmetic Fuchsian groups. This new class of codes satisfies the property full-diversity, linear dispersion and full-rate. Mathematical subject classification: 18B35, 94A15, 20H10

Hints of theta_13>0 from global neutrino data analysis

Nailing down the unknown neutrino mixing angle theta_13 is one of the most important goals in current lepton physics. In this context, we perform a global analysis of neutrino oscillation data, focusing on theta_13, and including recent results [Neutrino 2008, Proceedings of the XXIII International Conference on Neutrino Physics and Astrophysics, Christchurch, New Zealand, 2008 (unpublished)]. We discuss two converging hints of theta_13>0, each at the level of ~1sigma: an older one coming from atmospheric neutrino data, and a newer one coming from the combination of solar and long-baseline reactor neutrino data. Their combination provides the global estimate sin^2(theta_13) = 0.016 +- 0.010 (1sigma), implying a preference for \theta_13>0 with non-negligible statistical significance (~90% C.L.). We discuss possible refinements of the experimental data analyses, which might sharpen such intriguing indication.Comment: Minor changes in the text. Matches published version in PR